How read chest xr 8
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Based on the provided information, the most appropriate next step would be flexible bronchoscopy to further evaluate the abnormality seen on CXR.
How read chest xr 8
- 1. HOW READ CHEST XR -8 ANAS SAHLE ,MD
- 2. Brief review
- 3. POSITION PA AP QUALITY ROTATION PENETRATION INSPIRATION LESION OPACI OPACITY Homo Heterogenous Wellill defined Zone Centralperiph Silhouet eral sign TY Necrotic PATCHY MEDIASTINAL NODULE Central deviasionwided MASS COSTO-PHRENIC ANGEL Freeoblitern CAVITARY OTHER INFILTIRATION Bone soft tissuediaphragm
- 4. Consolidation Infection causes Non-infection causes Broncho- WEGNER Cardiac Pneumonia Lymphoma alveolar COP Sarcoid disease failure carcinoma
- 5. Solitary Pulmonary Nodule(SPN) • Is • Single. • Discrete. • intrapulmonary density. • < 3cm in diameter. • completely surrounded by aerated lung. • DDX: • Bronchogenic ca. • Solitary metastasis. • Granuloma (infectioninflamation). • Benign lung tumor(hamartoma). • Round pneumonia. • Round atelectasis. • AVM.
- 6. Solitary Pulmonary Nodule(SPN) Appearance Margin Calcification cavitation Comparison with a Size previous x-ray to >8mm <8mm Assess growth over time. Location Upperhillar zone Lowerbasesup-pleural Associated abnormalities Lymph node enlargement Rib destruction/erosion
- 7. Nodule Mass Nodule Mass • Well defined opacity it s • Well defined opacity more diameter up to 3cm. than 3cm. • The most common is: • The most common is: – Tuberculoma – Bronchgenic CA – Hamartoma – Hydatid cyst – Bronchogenic CA – metastases – Hydatid cyst – Metastases – AVM
- 33. Cavitary lesion Air-fluid level Air only Wall thickness Straight Wavy Thick Thin site ruptured Irregular inner Regular inner Abscess Hydatid wall wall Peripheral Central cyst Cavitating Chronic Emphesematous pneumatocele neoplasm abscess bulla
- 34. Case-1 • A 40-year-old man with a history of substance abuse and HIV infection is seen in the ER with complaints of: • fever, • weight loss, • production of foul-smelling sputum, • and shortness of breath for 2 wk. • On physical exam he is : • tachypneic • has clubbing of his digits. • Lung exam reveals: • diffuse rhonchi • and an area of egophony with whispering pectoriloquy in the right chest posteriorly. • ABGs reveal PaO2 of 59 mm Hg on room air.
- 35. CASE-1 What is the most likely diagnosis? a. Pneumococcal pneumonia b. PCP pneumonia c. Lung abscess d. Squamous cell carcinoma
- 36. POSITION •PA CXR QUALITY •Good Technical Quality •Round opacitiy with air-fluid level •In right upper zone near hilum LESION •Ill-defined linear opacity surrond it •Central trachea and mediasteinal. MEDIASTINAL ANGELS •Free costo-phrenic angels. OTHER •No
- 37. Case-2 • A 60-year-old man with a history of COPD and old TB is seen with • mild hemoptysis and chronic cough. • He is HIV negative and has been ill for about 2 wk. • Vital signs: pulse 110 bpm; temperature 101°F; respirations 24/min; blood pressure 108/70 mm Hg. • No skin lesions are noted. • Laboratory data: Hb 14 g/dL; HCA 42%; WBCs 8.7/μL; BUN 24 mg/dL; creatinine 0.8 mg/dL; sodium 131 mEq/L; potassium 4.3 mEq/L. • ABGs on RA: pH 7.37; PCO2 43 mm Hg; PO2 87 mm Hg. • Sputum tests reveal numerous AFB-positive organisms on smear. • Spirometry shows an obstructive ventilatory impairment with marginal reversibility.
- 38. Case-2
- 39. POSITION •PA CXR QUALITY •Poor Technical Quality •Cavitary lesion •In right upper zone LESION •Central trachea and mediasteinal. MEDIASTINALHilum •Right hilum pulled upward ANGELS •Disappear . •No OTHER
- 40. Case-2 • the most likely diagnosis is – a. Lung abscess – b. Non-TB mycobacteria – c. Actinomycosis – d. Aspiration pneumonia
- 41. Case-3 • A 60-year-old man with a past history of smoking for 30 years (he stopped 3 years ago, prior to cardiac bypass surgery). • is admitted with cough and mild hemoptysis. • He is afebrile with no shortness on breath. • Physical exam is negative except that the lung exam reveals rhonchi in the left upper lung zone.
- 42. Case-3
- 43. POSITION •PA CXR QUALITY •Poor Technical Quality •Well defined round density •(mass lesion) LESION •7*11cm. •In left para-hilar area. •Obscured aortic •Right deviated trachea. MEDIASTINALHilum ANGELS •Disappear . •No OTHER
- 44. Case-3 • The finding/abnormality most likely to occur with the lesion seen on the CXR: • Serum calcium of 13.6 mg/dL. • b. Sputum positive for fungal elements • c. Increased D-dimer levels. • d. Koilonychia.
- 45. Case-4 • A 38-year-old city worker presents with fever, chills, and cough with left-sided chest pain 2 days after the Mardi Gras festival. • She denies any hemoptysis, weight loss, or chronic illness. • Past history is unremarkable. • On physical exam, she has a BMI of 32; temperature is 101°F. • She was observed to have splinting of her right side during the inspiration.
- 46. Case-4
- 47. POSITION •PA CXR QUALITY •Poor Technical Quality •Well defined round density •(mass lesion) LESION •3*2,5 cm. •In right middle zone. •Cardiomegaly . MEDIASTINALHilum ANGELS •Hazy . •No OTHER
- 48. Case-4 • 1.The most likely diagnosis is: • a. Bronchogenic carcinoma • b. Round pneumonia • c. Alveolar sarcoidosis • d. Fungus ball • 2. Associated findings may include: • a. Hyponatremia • b. Increased ACE levels • c. Hypercalcemia • d. Clubbing
- 49. Case-5 • A 62-year-old female smoker presents with a history of “pneumonia” 6 wk ago. • She has been on multiple antibiotics, and although she feels relatively better now, • her CXR remains unchanged.
- 50. Case-5
- 51. POSITION •PA CXR QUALITY •Poor Technical Quality •Ill defined mass-like density •Behined heart shadow LESION •7*4 cm. •Silhoutte descending aorta. •Central tracheamediastinum . MEDIASTINALHilum ANGELS •Hazy . •No OTHER
- 52. Case-5 • The next step in the management of this patient will include: • a. Change of antibiotics • b. Sputum for TB • c. Flexible bronchoscopy. • d. Open lung biopsy